ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Hepatitis D virus infection
Print
Other Resources UpToDate PubMed

Hepatitis D virus infection

Print Images (1)
Contributors: Sama Kassira, James H. Willig MD, MSPH
Other Resources UpToDate PubMed

Synopsis

Hepatitis D (HDV) is caused by the hepatitis D virus, also known as delta virus or delta agent. It can affect the liver in a variety of ways and can lead to fulminant liver failure. Hepatitis D virus is a defective RNA virus requiring hepatitis B surface antigen (HBsAg) for pathogenicity (allows binding to hepatocytes and virion assembly). Thus HDV can be acquired simultaneously with hepatitis B (HBV) (co-infection) or in a previously HBsAg positive individual (super-infection). Co-infection with both HDV and HBV at the same time is associated with a more severe clinical outcome compared with HBV infection alone. Super-infection occurs when a chronically HBV-infected individual contracts HDV. Fifteen million of 350 million HBV patients are also infected with HDV.

HDV is transmitted most commonly through blood or blood products, though transmission can also occur by sexual contact, and much less commonly through vertical transmission. Recent studies have shown the highest prevalence of HDV transmission in patients ages 21-40 and have suggested sexual contact may be a more common route of transmission in this population than previously thought. Higher prevalence rates additionally occur in the Mediterranean regions, central / western Africa, northern Asia, Vietnam, and Amazonian areas. While rates of HDV were previously thought to be decreasing in North America and Europe, recent trends show increasing prevalence and highlight the need for screening HDV-negative individuals as well as counseling HDV-positive individuals for sexual transmission prevention.

Clinically, HDV infection may present asymptomatically, with symptoms of acute hepatitis, or with worsening of previously asymptomatic HBV infections. Signs and symptoms of HDV infection are nonspecific to this virus and include jaundice, pruritus, anorexia, fatigue, abdominal distention and ascites, and encephalopathy. Patients may also complain of dark-colored urine or pale stools.

Physical examination may reveal lowered blood pressure, yellow skin discoloration, spider angiomata, abdominal distention and ascites, hepatosplenomegaly, palmar erythema, Muehrcke nails, and Terry nails.

Immunocompromised Patient Considerations:

A substantially more aggressive progression of HDV may be associated with triple infection with HIV and HBV, and screening for HDV is recommended for HIV+ / HBV+ patients.

Codes

ICD10CM:
B17.8 – Other specified acute viral hepatitis

SNOMEDCT:
83617006 – Hepatitis D Virus

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 08/04/2015
Copyright © 2019 VisualDx®. All rights reserved.
Hepatitis D virus infection
Print 1 Images
Hepatitis D virus infection (Acute) : Dark urine, Fatigue, Jaundice, Nausea/vomiting, Anorexia, Arthralgia, RUQ pain
Copyright © 2019 VisualDx®. All rights reserved.